TRLOP perforators - Pros & cons

The advantages and disadvantages of TRansLuminal Occlusion of Perforators (TRLOP)

The biggest alternative to treating incompetent perforating veins (IPV) with transluminal occlusion of perforators (TRLOP) is to leave them completely alone and not treat them at all. Unfortunately, at the current time, this is a very common event and there is a great many doctors who perform vein surgery but still do not treat incompetent perforating veins (IPV).

Before 1985, doctors who wanted to treat perforating veins would have to do so by cutting open the leg and tying the veins off using surgical ties (ligations). This technique is clearly inferior to transluminal occlusion of perforators (TRLOP) for several reasons. Firstly even the smallest surgical incisions will be larger than the single needle hole needed for the transluminal occlusion of perforators (TRLOP) procedure and therefore would produce a worse cosmetic result as well is an increased risk of pain and infection. In addition, as with vein stripping, the open surgical technique with tying of the vein results in damage to the vein itself and therefore stimulation of the body to regrow the vein. In addition, many surgical ties are designed to dissolve in time, allowing the vein to reopen and the vein problem to re-occur.

In 1985 a surgeon called Hauer invented a procedure called sub-fascial endoscopic perforating vein surgery (SEPS) which was revolutionary in its time. Under general anaesthetic, a surgical endoscope was passed through an incision (usually between 1 and 3 cm) under the fat and above the muscle. The muscle layer has a lining called "fascia" which is like a tight stocking around the muscle itself. The endoscope was passed just under this "fascia" and just above the muscle. As it was passed forwards, perforating veins could be seen to pass across this space. At this point the veins can either be cut, burnt externally or clipped.

Until transluminal occlusion of perforators (TRLOP) was invented in 2000, sub-fascial endoscopic perforating vein surgery (SEPS) was the best way to treat incompetent perforating veins (IPV). However since the invention of transluminal occlusion of perforators (TRLOP), there is no need for sub-fascial endoscopic perforating vein surgery (SEPS).

Transluminal occlusion of perforators (TRLOP) is a local anaesthetic pin-hole technique causing minimal pain and no down-time. Sub-fascial endoscopic perforating vein surgery (SEPS) is a general anaesthetic technique with a larger scar that has a higher chance of infection, and has more pain - especially with the bruising of the muscle as the endoscope pushes past it. The bruising and discomfort usually lasts a couple of weeks. In terms of results, research published shows that the results of transluminal occlusion of perforators (TRLOP) are equivalent to sub-fascial endoscopic perforating vein surgery (SEPS) at both 1 year and 5 years after the procedure.

Recently some doctors have tried to use Foam Sclerotherapy to close incompetent perforating veins (IPV). Although this is also done under local anaesthetic, is minimally invasive, and also cheaper than transluminal occlusion of perforators (TRLOP), there are some questions that need to be answered before it is used in preference to transluminal occlusion of perforators (TRLOP).

Firstly, if the incompetent perforating vein (IPV) is a normal size for this condition (about 4 mm diameter) and normal length (often 1–2 cm especially around the ankle), it is almost impossible to fill the target vein adequately without foam going into the deep vein, risking damage of deep vein thrombosis (DVT). In addition, it is very hard, if not impossible, to get good compression on a vein that is diving deep to the surface, which is essential for good results with foam sclerotherapy.